3种麻醉方法在肺结核患者支气管镜诊疗中的效果分析  

Analysis of the effect of three anesthesia methods on bronchoscopy in patients with tuberculosis

作　　者：马盼盼 张晓栋 李金沛 张亮 余德慧 杨晓瑞 何仁亮[1] Ma Panpan;Zhang Xiaodong;Li Jinpei;Zhang liang;Yu Dehui;Yang Xiaorui;He Renliang(Department of Anesthesiology,The Third People's Hospital of Shenzhen,Guangdong Shenzhen 518112,China)

机构地区：[1]深圳市第三人民医院麻醉科,广东深圳518112

出　　处：《新发传染病电子杂志》2023年第5期25-28,共4页Electronic Journal of Emerging Infectious Diseases

基　　金：深圳市第三人民医院院内临床项目(G2022056)。

摘　　要：目的比较3种麻醉方法在肺结核患者支气管镜诊疗中的临床效果。方法选取深圳市第三人民医院2021年12月至2022年3月收治的无痛支气管镜病例90例,采用随机数表法分为局部麻醉(C组)、咪达唑仑复合瑞芬太尼组(M组)、咪达唑仑复合哌替啶联合环甲膜穿刺组(T组),每组30例。记录患者麻醉前(T0)、麻醉诱导后(T1)、气管镜进入声门时(T2)、检查过程中(T3)患者的血压(blood pressure,BP)、心率(heart rate,HR)、指脉血氧饱和度(SpO2);检查结束后记录患者苏醒时间、steward苏醒评分及不良反应发生率;记录患者满意度,并对麻醉效果进行判断。结果与T0相比,C组患者T2、T3时点BP、HR明显升高;M组患者T1时点BP、HR明显降低(P<0.05);T组患者无明显变化。与C组相比,M组T1、T2、T3时点BP、HR较低,T组T2、T3时点BP、HR较低(P<0.05)。C组患者不良反应发生率较高,麻醉优良率较低,患者满意度下降(P<0.05);T组苏醒时间明显缩短,苏醒评分、麻醉效果明显升高(P<0.05);仅M组有5例患者出现SpO2<90%。结论咪达唑仑复合哌替啶联合环甲膜穿刺用于肺结核患者无痛支气管镜检查,可有效降低呼吸抑制、呛咳等不良反应发生率,血流动力学更加平稳。Objective To compare the effect of three different anesthesia methods on bronchoscopy in patients with tuberculosis.Method 90 painless bronchoscopy cases admitted to the Third People's Hospital of Shenzhen from December 2021 to March 2022 were selected,and were randomly divided into three groups with 30 cases in each group:local anesthesia group(group C),midazolam combined with remifentanil group(group M),midazolam combined with meperidine combined with cricothyroid membrane puncture group(group T).BP,HR,and SpO2 were recorded before anesthesia(T0),after anesthesia induction(T1),bronchoscope inserted into the glottis(T2),and during operation(T3).The recovery time,steward recovery score,and the incidence of adverse reactions were recorded.And the patient's satisfaction,the anesthetic effect were observed.Result Compared with T0,MBP and HR at T2 and T3 time points in group C were significantly increased;BP and HR at T1 time point in group M were significantly decreased(P<0.05);There was no significant difference in group T.Compared with group C,BP and HR at T1,T2 and T3 time points were lower in group M,MBP and HR at T2 and T3 time points were lower in group T(P<0.05).In group C,the incidence of adverse reactions was higher,the anesthesia excellence rate was lower,and the patients’satisfaction was decreased(P<0.05).The recovery time was significantly shortened in group T,and the recovery score,anesthesia effect were significantly increased(P<0.05).Oxygen protection below 90%in 5 patients in group M only.Conclusion Midazolam compound pethidine combined with Cricothyroid membrane puncture is used for painless bronchoscopy in tuberculosis patients,which can effectively reduce the incidence of adverse reactions such as respiratory depression and cough,and the hemodynamics is more stable.

关 键 词：支气管镜 肺结核 麻醉 环甲膜穿刺 

分 类 号：R614[医药卫生—麻醉学] R523[医药卫生—外科学]